Further evidence for an ischemic origin of perforation of the appendix in the neonatal period

The importance of timely detection and management in neonatal appendicitis

“…Obstructive caecal distention in conditions such as Hirschsprung's disease or meconium ileus have also been reported to lead to appendiceal perforation 10. Finally, vascular insufficiency (secondary to perinatal asphyxia, cardiac defects, extracorpeal membrane oxygenation dependence or any other low flow or hypoxic states) is also believed to cause appendiceal perforation in the neonate 2 11. This is the most likely cause of neonatal appendicitis in our case, as the patient was asphyxiated at birth due to the developement of bilateral choanal atresia.…”

Neonatal appendicitis: a new look at an old zebra

“…First, argument persists in the literature that appendicitis in the first weeks of life is an isolated form of NEC, which suggests impaired immunity may increase susceptibility to appendicitis [2,5]. Second, an extension of the first proposal implicates vascular insufficiency as an underlying cause of neonatal appendiceal Other miscellaneous conditions Down's syndrome 1 Giacomoni et al, 1986 [20] Congenital ureteropelvic junction obstruction 1 Tucci et al, 1978 [29] perforation, as in conditions such as perinatal asphyxia, cardiac anomalies, patent ductus arteriosus, extracorporeal membrane oxygenation dependence, or other low-flow or hypoxic states [5,10]. This is the most likely scenario contributing to perforation of the appendix in our case, given the patient's cardiac anomalies and TEF, which may have predisposed the neonate to transient episodes of intestinal ischemia and resultant transmural perforation; this also could have caused the diffuse erosive mucosal inflammation seen histologically.…”

Isolated ruptured appendicitis presenting as pneumatosis intestinalis in a premature neonate

“…The infrequent occurrence and lack of specific clinical features in this age group contribute to the delay in diagnosis and a mortality rate of 20-25% according to recent data [1]. Although multifactorial, NA is often seen in association with diseases which impair blood supply to gut (perinatal asphyxia, cardiac anomalies, extra corporeal membrane oxygenation, patent ductus arteriosus, respiratory distress syndrome) or in conditions associated with cecal distension (Hirschsprung's disease, meconium ileus, inguinal or scrotal hernia, intestinal obstruction) or in association with impaired immunity or sepsis (prematurity, maternal chorioamnionitis) [2,3]. The incidence of perforation in NA approaches 85% [4].…”